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December 9, 2020

Community profile: New Orleans, Louisiana

Downtown New Orleans rises behind the French Quarter, as seen from a rooftop of the Bywater area. The St. Louis Cathedral is in the center.
Downtown New Orleans rises behind the French Quarter, as seen from a rooftop of the Bywater area. The St. Louis Cathedral is in the center.

It’s a brilliant, sunny day in February. Palms sway in the balmy breeze and the blooming tulip trees cast rippling shadows. The distant drumbeat of a marching band and the aroma of funnel cakes signal a parade is about to begin. Families gather along stately St. Charles Avenue. Children wave to masked float riders as purple, gold, and green Mardi Gras beads fly through the air. New Orleans might have been beaten by a hurricane, drowned by its lake, and humbled by its own dysfunction, but it still knows how to party.

Hurricane Katrina slammed into the city on August 29, 2005, and with the subsequent breach of the levees, New Orleans changed forever. This old port city, rich in history and culture, whose political tales and troubles sometimes sound fantastic enough to be fiction, continues to recover from the largest natural disaster in the history of the U.S. Not an easy task, particularly under the watchful eyes of the entire world.

Some aspects of the city’s rehabilitation haven’t progressed as swiftly as hoped. Current population estimates run as low as 40 percent of pre-Katrina numbers; the Road Home program has been criticized as confusing and ineffective; numerous destroyed homes remain untouched; and some of the most devastated areas have been further troubled by a surge in crime. Factor in the overarching theme - what’s true today in New Orleans might not be true tomorrow - and it all makes for significant challenges.

However, there is plenty of good news coming out of New Orleans, too. Determined natives and newcomers (French Quarter residents Angelina Jolie and Brad Pitt among the latter), along with a steady stream of committed volunteers from all across the country, and the ardent keeping of traditions like Mardi Gras have helped sustain the city’s unquenchable spirit.

In fact, much of New Orleans looks like its old self, just with a bit of a facelift. The Superdome has been restored. Renowned restaurants have reopened; the beloved Camellia Grill has been persuaded by a window filled with "Post-it" love notes to make a comeback. Magazine Street is brimming with boutiques and antiques. The Aquarium gleams in the sunlight. Pristine Audubon Park looks as if nothing more than a breeze rippled its stream. The Cajun Queen and the Creole Queen stand ready for a pleasure paddle down the mighty Mississippi River. The French Quarter is alive with its usual array of quirky characters and strolling tourists; music echoes along Bourbon Street and coffee shops are filled with people telling and retelling their stories. It’s this side of New Orleans that is often missed by the media.

"This is just like a barn-building for Americans," says Patrick Quinlan, MD, the CEO of Ochsner Health System. While the nation saw plenty of negative events after the hurricane, says Quinlan, "what you didn’t see was the 99 percent of the people who went way out of their way to help somebody else, even at great risk and great cost to themselves."

In the thick of the Katrina crisis, the medical profession produced many of the quiet heroes of the storm. In the weeks that followed, physicians and other workers delivered health care from tents in parking lots, in a vacated department store, and even in a mosque. Health care continues to be a critical force in the rebuilding of New Orleans. Working here comes with a unique perk - the chance to help breathe new life into one of the most fascinating cities in the world.

Opportunities in New Orleans

"I’d say that practicing in New Orleans right now is not for the faint of heart but, for the right person, I think it’s a really good opportunity," says Tyler Curiel, MD, MPH, the director of the San Antonio Cancer Institute and an adjunct professor of medicine at Tulane University School of Medicine. His co-authored article on health care in New Orleans following Hurricane Katrina and his perspective piece on the need for disaster training appeared in the New England Journal of Medicine. Considered one of the heroes of Hurricane Katrina, Curiel stayed throughout the storm, caring for patients at both Tulane University Hospital and Clinic and Charity Hospital, then helped to evacuate patients, carrying many of them through dark, hot stairwells to reach rescue helicopters. Afterward, he retrieved precious cancer research cells and samples and transported them safely to other facilities.

"For the person who ever thought they may want to try an academic setting but didn’t really want all the pressure of writing grants . . . right now would be an excellent time to look at Tulane or LSU because they need good clinical staff and everyone understands now that you can’t be writing big grants. . . .  It’s really more about building the clinical practice, teaching the students, and teaching the residents," says Curiel.

While Curiel believes it’s a difficult time in New Orleans for solo practitioners in almost any discipline, group practices that have a good handle on the needs of the local population present opportunities, particularly for specialties that are in demand. According to Curiel, there are needs in family medicine, general internal medicine, and subspecialties such as cardiology and diabetology. He cautions that with fewer school-age children in the city, pediatricians should look very carefully at the impact on pediatric practices in New Orleans.

"Probably the biggest specialty that is very far underrepresented and very much needed are people who have very good psychiatry skills and psychology skills," says Curiel. He adds that there is a lot of depression, post-traumatic stress, and anxiety in the entire population that cuts across all ages and socioeconomic groups.

In a February 14, 2007 article in The Times-Picayune, Louisiana State University Health Sciences Center announced plans to open a psychiatric hospital in Uptown New Orleans by summer 2007 to help relieve a critical shortage of inpatient mental health services. The dearth has shifted the burden to area emergency rooms that are seeing numerous patients in need of mental health services. Currently, acute psychiatric facilities in the city include the 35-bed New Orleans Adolescent Hospital and Kindred Hospital for elderly patients. In Harahan, a suburb of New Orleans, River Oaks Hospital is licensed for 100 inpatients, including units for children, adolescents, and adults.

The community’s regrouping

The flooding following the levee breaches re-defined the importance of location. Uptown hospitals, including Touro Infirmary and Children’s Hospital, escaped flooding and reopened relatively quickly. However, downtown hospitals were particularly hard hit. Charity Hospital suffered severe damages and remains closed, but the massive facility that long provided care for indigent patients will live on in the minds of many physicians who trained there. Charity was the site of the "Bullpen," a steep amphitheater where medical students were drilled so fiercely some fainted from fear.

LSU reopened University Hospital, including its new trauma center, helping to provide care for the uninsured. Reportedly, LSU plans to build a new hospital emphasizing teaching and research and hopes to partner with the Department of Veterans’ Affairs to share some resources when a new V.A. facility is complete. (The Times-Picayune).

Nearby Tulane University Hospital and Clinic also suffered flooding but reopened in February 2006 and currently has 90 fewer beds than pre-Katrina. Tulane’s facilities also include an Uptown outpatient clinic and Tulane-Lakeside Hospital in the suburb of Metairie.

With the closure of Charity, hospitals such as Touro, Ochsner, West Jefferson, and East Jefferson stepped in to provide care for uninsured patients after the storm. The state is in the process of reimbursing these hospitals as it considers a permanent redesign of the Louisiana health-care system. The legislative debate continues over whether to rebuild the charity system or to use those funds for government-financed private insurance policies. (The Times-Picayune).

Meanwhile, grass roots-efforts like the Common Ground Health Clinic (www.commongroundrelief.org) developed soon after Katrina to help meet basic needs. This particular program has grown substantially from its humble beginnings involving volunteer physicians from all over the U.S. Recently, it further solidified its presence in the city’s devastated Lower 9th Ward by opening a health clinic in a house. (New Orleans CityBusiness, March 1, 2007).

New opportunities will likely grow out of Ochsner’s recent expansion and purchase of three hospitals - one in Uptown New Orleans, another on the West Bank, and a third in Kenner near the Louis Armstrong New Orleans International Airport. According to Quinlan, Ochsner is currently the largest private employer in Louisiana. He sees these acquisitions as far more than providing essential health care, stating that, "We want them to be an anchor, a cornerstone for the rebuilding of those communities."

Ochsner shut down only for a few days during Katrina due to water shortage, but reopened quickly and served as an oasis during the crisis. Says Quinlan, "Our board gave us unfettered authority to stand up for our people inside the company and for our people in the community to just do the right thing." For him, fielding the challenges of the hurricane and its aftermath became an uplifting experience. "I was in my office for seven weeks. . . . Being with people who are at their best when situations are at their worst is inspiring."

Three-fourths of Ochsner’s staff had lost or damaged homes, says Quinlan. The institution’s family orientation showed during the crisis. "We provided housing, we rented large blocks of hotels, we provided…bus services, and we provided free meals for whomever needed them up through about June." The institution converted the cafeteria into a makeshift department store for donations and distributions of household goods and raised $3 million to help its employees recover and rebuild.

Ochsner also reached out to other institutions, creating space for Charity-LSU to set up a temporary trauma center. It continues to assist both Tulane and LSU medical schools by providing clinical rotations for students, residents, and fellows.

"We recognize that the future for New Orleans, the future for each institution is to work collaboratively together to create the national presence that we all want," says Quinlan. "The more we work together the more likely we all are to succeed as individuals, as institutions, as cities and as citizens."

Ochsner has rebuilt most of its facilities over the last five years and established an electronic medical records system - a great help when patients evacuated during the hurricane. As far as needs, "I don’t think we can hire enough people in any field right now," says Quinlan. "We thought recruiting might be difficult." But he’s discovering a different kind of applicants - individuals who want to be a part of the rebuilding process, who have a pioneer spirit, and who want to make a difference.

Arriving in a new New Orleans

One of the physicians who came to the city and joined Ochsner post-Katrina is attending neonatologist Matthew Cortez, MD. "People ask: ’Why did you come?’" says Cortez, who was drawn to the opportunity to serve in a leadership role relatively early in his career as well as to be a part of something bigger. "It was kind of a rebuilding of a system that has been there for years . . . the whole infrastructure of New Orleans itself," he says. He was in private practice for four years in Birmingham, Alabama then completed a fellowship in neonatology at Vanderbilt Children’s Hospital in Nashville prior to taking the position at Ochsner.

"Ironically, I was set to come back for my second interview [at Ochsner] the week of the storm," says Cortez. He was in contact with administrators throughout the crisis, but it didn’t dissuade him from coming to New Orleans. Cortez’s wife, a general pediatrician, has family in the New Orleans area, but he also was drawn to the city itself. "I came here to interview in 1995 for my residency and rode down the streetcar on St. Charles, and I just fell in love with it. It was something about this city. It’s got a really strong sense of community."

Cortez and his wife purchased a house on the North Shore of Lake Pontchartrain, a popular destination of many New Orleanians after the storm. The North Shore is connected to the New Orleans suburb of Metairie by 24 miles of causeway. With the shift in population, this area’s hospitals were forced to grow quickly, and there was a need for new roads, which are under construction. The demand for housing created a seller’s market for a time. Cortez and his wife were able to live with family and wait for the market to calm before buying, but then encountered the homeowner’s insurance challenge. "That was an interesting ordeal," says Cortez. They ultimately combined coverage from a company with a policy from a state-sponsored plan.

It took a little extra time and effort for medical student Ann Hansen and her husband to find housing in a safe area of post-Katrina New Orleans, but they succeeded. Hansen, who is in her first year at Tulane University School of Medicine, had lived in Baton Rouge ten years earlier, and she and her husband longed to return to Louisiana. But Hansen discovered a very different New Orleans than the one she’d seen before. "I didn’t realize the impact of Katrina until I came here."

During her admission interview, Hansen traveled to Houston where the school temporarily relocated after flooding. Despite the geographic changes, Hansen was impressed. "The actual soul of the school and the core of the school was unaffected," she says. "There was a tremendous school spirit." Though she had applied to other medical schools, Tulane was one of her top choices because of its reputation.

Interest in helping rebuild health care in New Orleans is particularly strong among medical students. The first-year class at Tulane University School of Medicine numbered 165 students, exceeding pre-Katrina admission by ten students.

Some courses have been downsized and some professors haven’t come back since the hurricane, says Hansen. But she is moved and inspired to be working among heroes. "They just seem like normal doctors and nurses but you hear the stories of what they did . . . taking care of patients and helping people throughout the Katrina disaster. I think there’s a very strong family feeling in those people, and it’s bound to make them stronger people and better doctors."

Preserving culture

Seeing people in the aftermath of a disaster "is a new cultural experience," says Hansen. "But it’s possible to have a pretty normal life here."

School is a fundamental part of that normal everyday life. "I know that many of the private schools have got availability and really good teachers," says Curiel, who has two children. Things have changed significantly in the New Orleans public schools, which have a longstanding history of problems. After the hurricane, the state took control of the public school system, and many have since become charter schools. But the storm took a toll on a number of special school programs, like music.

The public schools have long been carriers of traditions like music, says David Freedman, general manager of WWOZ, a nonprofit radio station in the French Quarter that plays jazz, blues, zydeco, Cajun, and other genres deeply rooted in New Orleans. The departure of many of the city’s musicians has given rise to serious concern about the survival of the New Orleans distinctive music culture - the brass bands, pleasure clubs, Mardi Gras Indians, and marching bands.

Before Katrina, an estimated 5,000 professional musicians lived in the city known as the "birthplace of jazz." Only a fraction have been able to return permanently. "There is a critical mass - and nobody knows what that critical mass is - that maintains a living music culture - the kind that’s been around in New Orleans since before the civil war," says Freedman. "There was a time before the flood when the city’s musicians could go out and play ten to twelve gigs a week." A special coalition called Sweet Home New Orleans is dedicated to helping musicians return to the city by serving as a one-stop resource for finding affordable housing, schools, health care, and addressing other issues musicians are facing.

The music culture in New Orleans is distinctive. Says Freedman, "It’s often said that New Orleans drummers can play with anyone in the world, but people coming in from the outside can’t play in New Orleans because they can’t get the rhythm." Freedman once enjoyed hearing kids blasting their trombones near the radio station after school but not now. He is working to restore music programs in the schools by raising funds to bring back school band directors.

"It all comes down to neighborhoods and people . . ." says Freedman. Music received its annual spring boost with the New Orleans Jazz and Heritage Festival featuring Norah Jones, Jerry Lee Lewis, Irma Thomas, and a long list of other well-known and not-so-well-known musicians.

Of course Jazzfest wouldn’t be a true New Orleans festival without food - poboys, gumbo, and crawfish everything from bread to pie. Though some of the best food in New Orleans can be found beneath a tent, the city boasts some of the world’s top chefs, including Emeril Lagasse, Paul Prudhomme, and Susan Spicer, to name just a few.

There are plenty of fun things to do in New Orleans besides eat and party. Families enjoy a world-class zoo, swamp tours, and a children’s museum that’s among the nation’s best. Sports fans are delighted by the return of the Saints football team, and the NBA Hornets split their time between New Orleans and Oklahoma City.

Many athletes find the mild, subtropical climate favorable. "I was able to participate in outdoor sports all year round," says Curiel, an ultradistance runner who holds the record for the Mardi Gras Ultra Distance Classic, a 125 mile footrace along the levee from Baton Rouge to New Orleans.

"New Orleans is one of my favorite cities of all times," says Curiel. "If you like fine dining, if you like history, if you like culture and the arts, it’s a really great city."

Not even killer Hurricane Katrina can change the fact that there is no place like New Orleans. Amid her charm and unloving spirit, unrivaled challenges remain. However, many of us who know her well believe New Orleans will rebuild better and stronger, and someday she’ll spin all the hardship into Lagniappe (Creole for "a little something extra"), only adding to her character and charisma. For now, the work goes on.

Susan Sarver is a freelance writer who lived in New Orleans for eleven years. She relocated to Chicago following Hurricane Katrina.



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